(1)
"Biologically based mental illness" means schizophrenia, schizoaffective
disorder, major depressive disorder, bipolar disorder, paranoia and other
psychotic disorders, obsessive-compulsive disorder, and panic disorder, as
these terms are defined in the most recent edition of the diagnostic and
statistical manual of mental disorders published by the American psychiatric
association.

(2) "Policy of
sickness and accident insurance" has the same meaning as in section
3923.01 of the Revised Code, but
excludes any hospital indemnity, medicare supplement, long-term care,
disability income, one-time-limited-duration policy that is
less than twelve months, supplemental benefit, or other policy
that provides coverage for specific diseases or accidents only; any policy that
provides coverage for workers' compensation claims compensable pursuant to
Chapters 4121. and 4123. of the Revised Code; and any policy that provides
coverage to medicaid recipients.

(B)
Notwithstanding section
3901.71 of the Revised Code, and
subject to division (E) of this section, every policy of sickness and accident
insurance shall provide benefits for the diagnosis and treatment of
biologically based mental illnesses on the same terms and conditions as, and
shall provide benefits no less extensive than, those provided under the policy
of sickness and accident insurance for the treatment and diagnosis of all other
physical diseases and disorders, if both of the following apply:

(1) The
biologically based mental illness is clinically diagnosed by a physician
authorized under Chapter 4731. of the Revised Code to practice medicine and
surgery or osteopathic medicine and surgery; a psychologist licensed under
Chapter 4732. of the Revised Code; a licensed professional clinical counselor,
licensed professional counselor, independent social worker, or independent
marriage and family therapist licensed under Chapter 4757. of the Revised Code;
or a clinical nurse specialist or certified nurse practitioner licensed under
Chapter 4723. of the Revised Code whose nursing specialty is mental
health.

(2) The
prescribed treatment is not experimental or investigational, having proven its
clinical effectiveness in accordance with generally accepted medical
standards.

(C) Division (B) of this section applies to all
coverages and terms and conditions of the policy of sickness and accident
insurance, including, but not limited to, coverage of inpatient hospital
services, outpatient services, and medication; maximum lifetime benefits;
copayments; and individual and family deductibles.

(D)
Nothing in this section shall be construed as prohibiting a sickness and
accident insurance company from taking any of the following actions:

(1)
Negotiating separately with mental health care providers with regard to
reimbursement rates and the delivery of health care services;

(2)
Offering policies that provide benefits solely for the diagnosis and treatment
of biologically based mental illnesses;

(3)
Managing the provision of benefits for the diagnosis or treatment of
biologically based mental illnesses through the use of pre-admission screening,
by requiring beneficiaries to obtain authorization prior to treatment, or
through the use of any other mechanism designed to limit coverage to that
treatment determined to be necessary;

(4)
Enforcing the terms and conditions of a policy of sickness and accident
insurance.

(E) An insurer that offers any policy of sickness and
accident insurance is not required to provide benefits for the diagnosis and
treatment of biologically based mental illnesses pursuant to division (B) of
this section if all of the following apply:

(1) The
insurer submits documentation certified by an independent member of the
American academy of actuaries to the superintendent of insurance showing that
incurred claims for diagnostic and treatment services for biologically based
mental illnesses for a period of at least six months independently caused the
insurer's costs for claims and administrative expenses for the coverage of all
other physical diseases and disorders to increase by more than one per cent per
year.

(2) The insurer
submits a signed letter from an independent member of the American academy of
actuaries to the superintendent of insurance opining that the increase
described in division (E)(1) of this section could reasonably justify an
increase of more than one per cent in the annual premiums or rates charged by
the insurer for the coverage of all other physical diseases and
disorders.

(3) The
superintendent of insurance makes the following determinations from the
documentation and opinion submitted pursuant to divisions (E)(1) and (2) of
this section:

(a) Incurred
claims for diagnostic and treatment services for biologically based mental
illnesses for a period of at least six months independently caused the
insurer's costs for claims and administrative expenses for the coverage of all
other physical diseases and disorders to increase by more than one per cent per
year.

(b) The increase
in costs reasonably justifies an increase of more than one per cent in the
annual premiums or rates charged by the insurer for the coverage of all other
physical diseases and disorders.

Any determination made by
the superintendent under this division is subject to Chapter 119. of the
Revised Code.